Title 08, Title 08: Banking and Insurance

§ 4073. Diabetes treatment (a) A health insurance plan shall provide coverage for the equipment, supplies, and outpatient self-management training and education, including medical nutrition therapy, for the treatment of insulin-dependent diabetes, insulin-using diabetes, gestatio…

§ 4074. Treatment of inherited metabolic disorders (a) As used in this section: (1) “Inherited metabolic disorder” means a disorder caused by an inherited abnormality of body chemistry for which the State screens newborn infants. (2) “Low protein modified food product” means a fo…

§ 4075. Craniofacial disorders (a)(1) A health insurance plan shall provide coverage for diagnosis and medically necessary treatment, including surgical and nonsurgical procedures, for a musculoskeletal disorder that affects any bone or joint in the face, neck, or head and is the…

§ 4076. Home health services (a) As used in this section: (1) “Home health agency” means a nonprofit home health agency that has been certified under Title XVIII of the Social Security Act (42 U.S.C. § 1395 et seq.). (2) “Home health care” means care and treatment provided by a h…

§ 4077. Reproductive health care services (a)(1) A health insurance plan shall provide coverage for outpatient contraceptive services including sterilizations, and shall provide coverage for the purchase of all prescription contraceptives and prescription contraceptive devices ap…

§ 4078. Midwifery coverage [Effective January 1, 2027; see also 8 V.S.A. § 4078 effective until January 1, 2027 set out above] (a) A health insurance plan providing maternity benefits shall also provide coverage for services rendered by a midwife licensed pursuant to 26 V.S.A. ch…

§ 4079. Abortion and abortion-related services (a) As used in this section, “abortion” means any medical treatment intended to induce the termination of, or to terminate, a clinically diagnosable pregnancy except for the purpose of producing a live birth. (b)(1) A health insuranc…

§ 4080. Anesthesia for certain dental procedures (a) As used in this section: (1) “Ambulatory surgical center” has the same meaning as in 18 V.S.A. § 2141. (2) “Anesthesiologist” means a physician who is licensed under 26 V.S.A. chapter 23 or 33 and who either: (A) has completed …

§ 4081. Tobacco cessation (a) As used in this section, “tobacco cessation medication” means all therapies approved by the U.S. Food and Drug Administration for use in tobacco cessation. (b) A health insurance plan shall provide coverage of at least one three-month supply per year…

§ 4082. Early childhood development disorders (a) As used in this section: (1) “Applied behavior analysis” means the design, implementation, and evaluation of environmental modifications using behavioral stimuli and consequences to produce socially significant improvement in huma…

§ 4083. Services for victims of sexual assault (a) As used in this section, “sexual assault examination” means either or both of the following: (1) a physical examination of the patient, documentation of biological and physical findings, and collection of evidence; and (2) treatm…

§ 4091. Definitions As used in this subchapter: (1) “Direct solicitation” means direct contact, including telephone, computer, email, instant messaging, or in-person contact, by a pharmacy provider or its agent to an individual covered under a health insurance plan without the co…

§ 4092. Prescription drug coverage (a) A health insurance plan shall not include an annual dollar limit on prescription drug benefits. (b) A health insurance plan shall limit a covered individual’s out-of-pocket expenditures for all prescription drugs to not more for self-only an…

§ 4093. Retail pharmacies; filling of prescriptions (a) A health insurer or pharmacy benefit manager doing business in Vermont shall permit a retail pharmacist licensed under 26 V.S.A. chapter 36 to fill prescriptions for all prescription drugs in the same manner and at the same …

§ 4095a. Colorectal cancer screening (a) As used in this section, “colonoscopy” means a procedure that enables a health care professional to examine visually the inside of a patient’s entire colon and includes the concurrent removal of polyps or biopsy, or both. (b) A health insu…

§ 4095b. Mammography and other breast imaging services (a)(1) A health insurance plan shall provide coverage for screening mammography and for other medically necessary breast imaging services upon recommendation of a health care professional as needed to detect the presence of b…

§ 4095c. Prostate cancer screenings A health insurance plan shall provide coverage for prostate cancer screenings consistent with the recommendations of the Centers for Disease Control and Prevention or upon recommendation of the covered individual’s health care professional. Ben…

§ 4095d. Chemotherapy treatment and oral anticancer medications (a) A health insurance plan shall provide coverage for medically necessary growth cell stimulating factor injections taken as part of a prescribed chemotherapy regimen. (b) A health insurance plan shall provide cover…

§ 4095e. Clinical trials for cancer patients (a) The Commissioner shall, after notice and hearing, adopt rules requiring that all health insurance plans issued in this State provide coverage for routine costs for covered individuals who participate in cancer clinical trials. (1) …

§ 4095f. Off-label use of prescription drugs for cancer (a) As used in this section: (1) “Medical or scientific evidence” means one or more of the following sources: (A) peer-reviewed scientific studies published in or accepted for publication by medical journals that meet nation…

§ 4098a. Coverage of health care services delivered through telemedicine and by store-and-forward means (a) As used in this section: (1) “Distant site” means the location of the health care provider delivering services through telemedicine at the time the services are provided. (…

§ 4098b. Coverage of health care services delivered by audio-only telephone (a) As used in this section, “health care provider” means a person, partnership, or corporation, other than a facility or institution, that is licensed, certified, or otherwise authorized by law to provid…

§ 4098c. Covered services provided by naturopathic physicians (a) A health insurance plan shall provide coverage for medically necessary health care services covered by the plan when provided by a naturopathic physician licensed in this State for treatment within the scope of pra…

§ 4098d. Covered services provided by athletic trainers (a) To the extent a health insurance plan provides coverage for a particular type of health care service or for any particular medical condition that is within the scope of practice of athletic trainers, a licensed athletic …

§ 4098e. Choice of providers for vision care and medical eye care services (a) As used in this section: (1) “Covered services” means services and materials for which reimbursement from a vision care plan or other health insurance plan is provided by a member’s or subscriber’s pla…